Information Collection

Children's Hospital GME Annual Report Screeing Instrument

IC 182195 under ICR 201308-0915-001 · OMB 0915-0313.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Children's Hospital GME Annual Report Screeing Instrument	Form and Instruction
1 Hospital Fianance Staff HRSA 100-1 HRSA 100-1 FY13.xlsm	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Hospital Fianance Staff HRSA 100-1	HRSA 100-1 FY13.xlsm		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	54	-2	56
Annual IC Time Burden (Hours)	562	47	515
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.